Provider Demographics
NPI:1194759381
Name:L.A. BEBENSEE DO PC
Entity type:Organization
Organization Name:L.A. BEBENSEE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LONETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEBENSEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-471-4445
Mailing Address - Street 1:2020 CHESTNUT ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5321
Mailing Address - Country:US
Mailing Address - Phone:479-471-4445
Mailing Address - Fax:479-471-2026
Practice Address - Street 1:2020 CHESTNUT ST
Practice Address - Street 2:SUITE 108
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-471-4445
Practice Address - Fax:479-471-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4053208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5M905Medicare PIN
ARG30035Medicare UPIN